1/9. pellagra in 2 homeless men.pellagra is a nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. Untreated, pellagra is fatal. Two cases of pellagra in contemporary homeless people are described. Complete evaluation supported a clinical diagnosis of pellagra after exclusion of other possibilities. signs and symptoms resolved after institution of niacin therapy and change in diet. Appropriate suspicion for a diagnosis of pellagra requires attention to a combination of socioeconomic and behavioral risk factors for nutritional deficiency. The combination of homelessness, alcohol abuse, and failure to eat regularly--particularly, failure to make use of shelter-based meal programs--may identify people at special risk in contemporary settings.- - - - - - - - - - ranking = 1keywords = alcohol abuse, alcohol, abuse (Clic here for more details about this article) |
2/9. Acute hemorrhagic pellagra in an Albanian refugee.We report a peculiar case of hemorrhagic pellagra in an exhausted Albanian refugee who had walked for 3 days under sunny skies on his way from his country to greece. The peculiarities of the case are the fulminant course of the disorder; the "terrifying" appearance of the patient (initially he was admitted to an emergency unit); the gangrenous appearance of the hemorrhagic lesions of the palms and fingernails; the disturbed hepatic function that gradually returned to normal; and the absence of a history of alcohol consumption, alcohol malabsorption, or drug intake.- - - - - - - - - - ranking = 0.040143310002119keywords = alcohol (Clic here for more details about this article) |
3/9. pellagra encephalopathy following B-complex vitamin treatment without niacin.pellagra is caused by nicotinic acid deficiency; it is rarely encountered in developed countries, and it is mainly related to poverty and malnutrition, as well as with chronic alcoholism. We report the case of an alcoholic patient who was diagnosed with pellagra and administered B-complex vitamin tablets that did not contain niacin. A few weeks later, the patient developed nervousness, irritability, insomnia and, consequently, delusional ideas and hallucinations, for which he had to be hospitalized. After his admission, the patient manifested loss of consciousness and myoclonus. All of his symptoms (cutaneous, neurological, and psychiatric) resolved fully with treatment with niacin in combination with other B-complex vitamins. All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid.- - - - - - - - - - ranking = 0.060214965003178keywords = alcohol (Clic here for more details about this article) |
4/9. pellagra: a rare disease observed in a victim of mental and physical abuse.Lesions of the brain stem and cerebellum due to nutritional deficiencies are mostly seen in chronic alcohol abuse and more rarely in severe malnutrition. We report the case of a 27-year-old woman, found dead in the family flat. She presented cachexia (167 cm, 25 kg) and multiple hematomas of the limbs. Postmortem examination revealed lesions due to peritonitis. Neuropathological examination showed severe atrophy of the corpus callosum and central neuronal chromatolysis, which are observed in pellagra. Inflammatory colitis or celiac disease was not found. Toxicological analysis was negative, in particular no alcohol absorption. pellagra, which is due to nicotinamide deficiency, is a disease rarely seen in this country. In this case, nutritional deficiency was the consequence of failure to eat in a context of abuse. The woman was born of an incestuous relationship and presented intellectual retardation due to poor affective relations with her mother.- - - - - - - - - - ranking = 1.0273608248623keywords = alcohol abuse, alcohol, abuse (Clic here for more details about this article) |
5/9. Alcoholic pellagra encephalopathy combined with Wernicke disease.Clinical and postmortem findings of a case that had combined alcoholic pellagra encephalopathy and Wernicke disease are described. This 51-year-old malnourished and chronic alcoholic man presented with progressive mental deterioration, pellagra dermatitis, hypertonus of the neck and other musculatures, myoclonic jerks with bizarre involuntary movements, in addition to total external ophthalmoplegia and gait disturbance. After administration of multivitamins, including thiamine and nicotinamide, these neurologic abnormalities were dramatically improved in a few days. However, the patient died thereafter because of sepsis associated with pneumonia. Postmortem examination revealed marked abnormalities in CNS, characterized by diffuse atrophy of gray matter and widespread neuronal degeneration and characteristic central chromatolysis in pontine nuclei, dentate nuclei, cranial nerve nuclei in the brain stem, Betz cells of the cerebral cortex, and Clarke's column and anterior horn cells of the spinal cord. There were also atrophy and gliosis of the mammillary bodies, degeneration and vascular proliferation of periaqueductal gray matter, and massive gliosis around the third ventricle. These neuropathological changes were compatible with symptoms of both alcoholic pellagra encephalopathy and Wernicke's disease, but they were also strongly suspected on clinical grounds.- - - - - - - - - - ranking = 0.060214965003178keywords = alcohol (Clic here for more details about this article) |
6/9. The clinical spectrum of alcoholic pellagra encephalopathy. A retrospective analysis of 22 cases studied pathologically.A retrospective clinical study of 22 heavy alcohol drinkers is reported in which postmortem study showed diffuse chromatolysis of neurons identical to that found in neurological pellagra, associated in 13 cases with marchiafava-bignami disease and/or Wernicke-Korsakoff disease. The clinical features included confusion and/or clouding of consciousness, marked oppositional hypertonus ('gegenhalten') and myoclonus. Because of the frequent coexistence of other alcoholic encephalopathies in the same patient, alcoholic pellagra was often unrecognized. Fifteen patients received thiamine and pyridoxine therapy without niacin. It appeared to aggravate the neurological state or to trigger the development of alcoholic pellagra encephalopathy in 9 cases. The relationship between pellagra occurring during thiamine and pyridoxine therapy and 'nicotinic acid deficiency' is discussed. Multiple vitamin therapy should be given in the treatment of undiagnosed encephalopathies in alcoholic patients.- - - - - - - - - - ranking = 0.18064489500953keywords = alcohol (Clic here for more details about this article) |
7/9. pellagra among chronic alcoholics: clinical and pathological study of 20 necropsy cases.Twenty cases of pellagra, diagnosed on neuropathological grounds, were found amont 74 necropsy cases of chronic alcoholism. Although these patients had presented with various mental, neurological and gastrointestinal symptoms, the diagnosis of pellagra had not been established clinically because, in the majority, there were no skin lesions. It is emphasised that whenever chronic alcoholics exhibit certain mental, neurological or gastrointestinal symptoms, one should strongly suspect pellagra even in the absence of skin lesions (pellagra sine pelle agra).- - - - - - - - - - ranking = 0.12042993000636keywords = alcohol (Clic here for more details about this article) |
8/9. Acute encephalopathy due to coexistent nicotinic acid and thiamine deficiency.We report the case of an alcoholic woman with confusion, catatonia and extrapyramidal signs, who developed features of the Wernicke-korsakoff syndrome after treatment with intravenous high potency vitamins. We emphasise that this should arouse the suspicion of nicotinic acid deficiency even in the absence of gastrointestinal symptoms or skin lesions.- - - - - - - - - - ranking = 0.020071655001059keywords = alcohol (Clic here for more details about this article) |
9/9. The "gauntlet" of pellagra.A 48-year-old alcoholic Filipino man presented to the outpatient department with a 2-year history of an eruption in a photosensitive distribution and episodes of mild diarrhea. He was otherwise in good health. Dermatologic examination revealed a browny-red coloration, with a sharply demarcated erythematous border, affecting both hands and lower forearms, where it was striking in its symmetry (Fig. 1). Around the neck, it was typical of a casal's necklace. The fronts and backs of the legs and the dorsa of the feet were also erythematous. The patient showed no evidence of mental confusion. A clinical diagnosis of pellagra was made based on the morphology, and treatment with nicotinamide 500 mg daily was instituted. The eruption quickly improved and resolved in 2 weeks (Fig. 2).- - - - - - - - - - ranking = 0.020071655001059keywords = alcohol (Clic here for more details about this article) |